I’m sure we have all heard the running joke about the endless list of side effect information women have to deal with when opening a pack of birth control. But have many women have taken the time to read and truly understand what the information means. Beyond the usual disclaimers exists the risk of physical and emotional effects that often get overlooked.

Essentially, this form of contraceptive works by “tricking the body into thinking it is pregnant”, suppressing the hormones that trigger ovulation. Without ovulation, no egg can be released, so pregnancy is not possible. Named the combined oral contraceptive pill (COC), this extremely common form of birth control contains both oestrogen and progesterone. Containing both predominant female sexual hormones adds to its effectiveness by pregnancy mimicking (progesterone) alongside the stabilisation of endometrial lining (oestrogen).

However, as expected, tricking your body into thinking it has entered a state of procreation has its issues. As displayed in the extensive brochure women receive when opening a pack of COC, there are common, uncommon and rare side effects. From dizziness, mood swings and headaches, all the way to high blood pressure, blood clots and oestrogen related cancers, the list looks never ending.

But, even with these known issues, COC is still readily prescribed to young women for a range of health problems. In fact, under the NHS, it is common practice to prescribe these pills for women to treat conditions such as acne and polycystic ovary syndrome (PCOS). The reasons for this stems from its “hormonal regulation”. Meaning, if you suffer from low progesterone/high oestrogen PCOS, giving this pill would stop cysts from showing on the ovaries. However, as soon as one stops the pill, the cysts typically return alongside worsened quality of life related symptoms. The same goes for acne which is also inherently a hormonal disorders.

This means that instead of going to the root cause and attempting to understand and fix the hormonal disorder, it is common for the NHS to prescribe pills that are known to manage symptoms. In other words, a woman with PCOS is prescribed the COC pill, given it for as long as they can handle, and then left to face all the PCOS related outcomes when they attempt to get pregnant.

But, the issues don’t stop there. According to the World Health Organisation, the combined oral contraceptive pill is a type 1 on the Institute Agency for Research on Cancer scale. This means, alongside processed meats, tobacco, air pollution, the combined birth control pill shows sufficient evidence of carcinogenicity in humans. Yet, it is still one of the most prescribed pill in female human history.

Multiple large scale analyses shows that women who have recently or currently use COCs face about a 25% higher relative risk of breast cancer compared to non-users. However, this risk appears to decline over time post consumption with an almost complete disappearance after 10 years. ADD

Essentially, both oestrogen and progesterone hormones stimulate breast cell division, increasing opportunities for DNA replication errors, which can lead to cancer development over time. The risk is generally small due to the short period of time most women stay on COCs, but for those who are primary users, their risk is serious.

Given that the combined oral contraceptive pill is classified as a carcinogen, it means that it has the potential to cause mutations in the DNA of cells. Normally, DNA mutations arise spontaneously and are relatively extremely rare during cell division, and the body has many repair mechanisms to correct such errors. However, carcinogens bypass these pathways causing irreparable DNA damage and evading immune detection. This means that even in a perfectly healthy bodily environment, where other cancer promoting factors are non-existent, mutations can still start. However, the COC pill is slightly different. Instead of directly mutating DNA, it instead acts as a hormonal carcinogen, meaning it increases cancer risk through hormonal modulation. In other words, it increases the chances of spontaneous DNA errors.

Therefore, it is of no surprise to me that young women in the UK are turning away from governmental supplied oral birth control. Data shows a notable decline over the last decade with a 50% drop of their main contraceptive method, and a big shift into natural fertility management methods even given its higher failure rate (usually due to its inconsistent or incorrect use). Despite greater dependency on user accuracy, the shift has been primarily taken by Gen Z women, showing a 700% rise in users in the last 5 years.

The combined oral contraceptive pill has become part of everyday live for millions of women across the globe. Whilst high levels of pregnancy prevention are guaranteed with correct consumption, the potential health risks it carries should not be ignored. Even though the increased risk for serious side effects are relatively small, including breast cancer, they are real and supported by strong evidence.

For an increasing number of young women, particularly in the UK, this awareness is producing a conscious shift away from long-term hormonal contraception toward natural fertility methods, even with the lower reliability trade-off. Ultimately, the conversation around the pill should not end with it being labeled as “good” or “bad”. Instead, we should enable all birthing-age women to make an informed decision around their own health through complete information transparency.